Cov kws kho mob ntseeg tias yog tias myocardial hypertrophy yog asymptomatic, ces txhua yam tuaj yeem xaus rau ntawm lub plawv nres. Nws yog qhov txaus ntshai thaum qhov no tshwm sim rau cov tub ntxhais hluas thiab cov neeg noj qab haus huv sab nraud uas mus rau hauv kev ua si. Yuav ua li cas tshwm sim thaum lub sij hawm tus kab mob no, dab tsi yuav tshwm sim thiab seb qhov no pathology yog kho - tseem yuav pom nyob rau hauv tsab xov xwm no.
Kev piav qhia ntawm pathology
Nws yog hu ua autosomal dominant kab mob, uas yog kis tau los ntawm cov noob caj noob ces thiab noob hloov, cuam tshuam rau lub plawv. Tus kab mob no yog yus muaj los ntawm ib tug nce nyob rau hauv lub thickness ntawm cov phab ntsa ntawm lub ventricles. Feem ntau, cov pathology yog asymmetric, sab laug ventricle ntawm lub plawv yog ntau cuam tshuam. Qhov no ua rau:
- tsim ntawm qhov chaw fibrosis;
- qhov txhab ntawm cov hlab ntsha me me;
- kev sib hloov ntawm cov leeg nqaij;
- ntshav ntws thaiv - kev hloov pauv ntawm lub mitral valve, uas tiv thaivejection ntshav los ntawm atrium.
Ventricular myocardial hypertrophy yog ib yam kab mob hnyav heev.
Thaum muaj qhov hnyav ntawm myocardium, uas yog tshwm sim los ntawm ntau yam kab mob, cwj pwm phem, kev ua si, lub cev yuav pib tiv thaiv nws tus kheej. Lub plawv yuav tsum tau tiv nrog kev nce ntim ntawm kev ua haujlwm yam tsis tas yuav nce lub load rau ib chav tsev ntawm qhov loj. Hauv qhov no, kev them nyiaj yuav tshwm sim:
- nce hauv myocardial cov leeg nqaij;
- nce protein ntau ntau;
- wall thickening;
- hyperplasia - tus lej ntawm cov hlwb nce.
Pathological myocardial hypertrophy
Nrog rau kev ua haujlwm ntev ntawm myocardium nyob rau hauv kev thauj khoom, uas tau nce tas li, cov kab mob pathological ntawm hypertrophic cardiomyopathy tshwm sim. Lub siab hypertrophied yuav tsum hloov mus rau cov xwm txheej tshiab. Lub myocardium thickens sai heev. Hauv qhov no tshwm sim:
- kev tsis ua haujlwm;
- kev cuam tshuam ntawm cov paj hlwb ntawm cov txheej txheem metabolic hloov pauv;
- kev loj hlob ntawm cov hlab ntsha thiab capillaries lags qab;
- cov qauv myocardial hnav tawm;
- repolarization tsis meej;
- tshwm sim systolic, diastolic dysfunction.
Kev kuaj mob ntawm cov neeg ncaws pob
Kev tsim ntawm myocardial hypertrophy hauv cov neeg ncaws pob yuav luag tsis pom. Raws li qhov tshwm sim ntawm kev tawm dag zog lub cev, lub plawv pib tso ntshav ntau dua, thiab cov leeg nqaij pib loj tuaj. Hypertrophy yog qhov txaus ntshai heev, vim tias thaum tsis muaj tsos mob thiab tsis txaus siabmuaj mob plawv, mob stroke, sudden cardiac arrest. Txhawm rau kom tsis txhob muaj teeb meem, koj yuav tsum tsis txhob tso tseg sai sai ua si kis las.
Hypertrophy hauv cov kis las muaj peb hom:
- Concentric hypertrophy - myocardium nce, cov kab noj hniav ventricular tseem tsis hloov pauv. tshwm sim hauv kev ua si zoo li qub thiab kev ua si.
- Eccentric hypertrophy yog kev hloov pauv cov leeg nqaij. Ib yam rau cov kev ua si dynamic (ntev deb, caij skiing, ua luam dej).
- Kev sib xyaw hypertrophy - kev ua si kis las uas tsis muaj zog thiab muaj zog siv tib lub sijhawm (kev caij tsheb kauj vab, rowing, skating).
Thaum kuaj pom tus kab mob no hauv tus menyuam
Myocardial hypertrophy tuaj yeem tshwm sim thaum yug los. Nws yog ib qho nyuaj rau kuaj tus kab mob no thaum muaj hnub nyoog no. Feem ntau, hypertrophic hloov nyob rau hauv myocardium tau pom nyob rau hauv thaum yau, thaum lub sij hawm active kev loj hlob ntawm cardiomyocyte hlwb. Cov phab ntsa pem hauv ntej thiab tom qab thicken mus txog 18 xyoo, ces lawv nres. Qhov tshwm sim ntawm ventricular hypertrophy nyob rau hauv cov me nyuam tsis yog suav hais tias yog ib qho kab mob sib cais, nws yog ib qho kev qhia ntawm lwm yam pathologies. Cov menyuam yaus uas muaj tus mob no feem ntau muaj:
- myocardial dystrophy;
- angina;
- mob plawv;
- siab.
Cas of cardiomyopathy
Nws yog qhov tsim nyog los cais thawj thiab theem nrab ua rau hypertrophy. Yam Tseem Ceeb:
- kev nyuaj siab;
- kis kab mob;
- dej cawv;
- overweight;
- kev tawm dag zog ntau dhau;
- tshuaj lom lom;
- siv tshuaj;
- pathological hloov thaum cev xeeb tub;
- microelement deficiency hauv lub cev;
- malnutrition;
- kab mob autoimmune;
- smoking.
Secondary ua rau myocardial hypertrophy suav nrog:
- Nkauj kho siab.
- IHD.
- kab mob neuromuscular.
- Mitral valve insufficiency.
- Aortic stenosis.
- Hypertension.
- Electrolyte imbalance.
- kab mob ntsws.
- Cov txheej txheem Parasitic.
- Kev tsis zoo ntawm cov txheej txheem metabolic.
- Tsis muaj oxygen hauv cov ntshav.
- Ventricular septal raug mob.
- Cov kab mob endocrine.
Cia peb saib ze dua ntawm cov cim ntawm sab laug ventricular myocardial hypertrophy.
Hypertrophy ntawm sab laug ventricle ntawm lub plawv
Feem ntau cov kab mob cuam tshuam rau phab ntsa ntawm sab laug ventricle. Qhov laj thawj tseem ceeb yog nce siab, uas ua rau myocardium ua haujlwm nrawm dua. Raws li qhov tshwm sim ntawm xws li overloads, phab ntsa ntawm sab laug ventricle pib loj tuaj. Hauv qhov no tshwm sim:
- poob ntawm myocardial cov leeg elasticity;
- kev ua txhaum ntawm kev ua haujlwm ntawm lub siab;
- slowing ntshav ncig;
- appearstxaus ntshai ntawm kev ntxhov siab nyob rau hauv lub siab.
Nrog myocardial hypertrophy ntawm sab laug ventricle ntawm lub plawv, qhov xav tau ntawm lub plawv rau oxygen thiab cov as-ham nce. Koj tuaj yeem tshawb pom cov kev hloov pauv ntawm sab laug ventricular hypertrophy siv kev ntsuas ntsuas. Muaj ib tug syndrome ntawm me ejection - fainting, kiv taub hau. Cov cim qhia uas nrog hypertrophy:
- mob siab;
- siab poob;
- arrhythmia;
- angina;
- tsis muaj zog;
- tsis zoo;
- mob taub hau;
- ua tsis taus pa thaum so;
- lub plawv dhia nrog kev tawm dag zog me ntsis;
- kev nyuaj siab.
Txoj cai atrial hypertrophy
Thickening ntawm phab ntsa ntawm txoj cai ventricle tsis yog kab mob, nws yog anomaly uas tshwm sim thaum muaj congestion nyob rau hauv cheeb tsam no. Qhov no tshwm sim los ntawm qhov tau txais ib qho loj ntim ntawm cov ntshav venous los ntawm cov hlab ntsha loj. Cov laj thawj no yuav yog:
- stenosis;
- yug tsis xws luag;
- obesity;
- Atrial septal defects, uas cov ntshav ib txhij nkag mus rau sab xis thiab sab laug ventricles.
Nrog txoj cai ventricular hypertrophy, cov tsos mob tshwm sim:
- kiv taub hau;
- mob plab;
- hemoptysis;
- fainting;
- ua tsis taus pa tsis muaj zog;
- bloating;
- cim qhia ntawm lub plawv tsis ua hauj lwm - lub siab loj, o ob txhais ceg;
- arrhythmia;
- mob hnoos;
- ua haujlwm tsis zoo ntawm lub cev hauv nruab nrog cev;
- hnyav hauv hypochondrium;
- cyanosis ntawm daim tawv nqaij;
- cov leeg loj hauv plab.
Ventricular septal hypertrophy
Ib qho ntawm cov cim qhia ntawm kev loj hlob ntawm tus kab mob yog hypertrophy ntawm interventricular septum. Lub ntsiab yog vim li cas rau qhov no pathology yog noob hloov. Xws li hypertrophy provokes:
- atrial fibrillation;
- mitral valve pathology;
- pab ntshav tawm;
- ventricular fibrillation;
- ventricular tachycardia;
- lub plawv tsis ua hauj lwm;
- pab ntshav tawm;
- mob plawv.
Symptoms of cardiac hypertrophy
Qhov phom sij ntawm myocardial hypertrophy yog tias nws feem ntau ploj mus yam tsis muaj tsos mob. Thiab tus kab mob no feem ntau kuaj tau los ntawm lub caij nyoog ntawm kev kuaj lub cev. Thaum lub sij hawm kev loj hlob ntawm tus kab mob, koj tuaj yeem soj ntsuam cov cim hauv qab no:
- ua tsis taus pa thaum so;
- fainting;
- mob plab;
- faus;
- lub plawv dhia tsis zoo;
- ua tsis taus pa;
- drowsy;
- edema;
- tsis muaj zog;
- kiv taub hau.
Cov tsos mob ntawm myocardial hypertrophy yog qhov tseem ceeb kom paub txog lub sijhawm.
Kev faib tawm ntawm hypertrophy
Cov kws tshaj lij kom yooj yim hauv kev ua haujlwm paub qhov txawv ntawm cov hauv qab no ntawm myocardial hypertrophy:
- symmetrical - tag nrho cov phab ntsa ntawm sab laug ventricle raug cuam tshuam;
- asymmetric - tsuas yog ib phab ntsa cuam tshuam;
- apical - cov leeg ntawm lub plawv nce saum toj;
- obstructive - rau txhua tussquare, nyob rau sab saum toj ntawm muab faib;
- non-obstructive - cov tsos mob me, pom tshwm sim.
Kev kuaj mob ntawm hypertrophic cardiomyopathy
Nyob rau theem pib, nrog kev txhim kho me ntsis ntawm hypertrophy, nws nyuaj heev los txheeb xyuas tus kab mob. Cov txheej txheem kuaj mob pib nrog kev xam phaj tus neeg mob thiab feem ntau pom cov ntsiab lus hauv qab no:
- kev mob yav dhau los;
- muaj kab mob hauv cov txheeb ze;
- hluav taws xob yuam qhov tseeb;
- tuag ntawm ib tug txheeb ze thaum yau;
- kos npe sab nraud thaum kuaj pom;
- ntsuas ntsuas ntshav thiab zis;
- nyeem ntshav siab.
Muaj cov kev taw qhia tshiab xws li kev kuaj mob caj ces ntawm myocardial hypertrophy. Nws yuav pab txheeb xyuas qhov tsis sib xws ntawm HCM, kho vajtse thiab cov txheej txheem hluav taws xob:
- Ultrasound tuaj yeem ntsuas myocardial thickening thiab impaired ntshav txaus;
- ECG yuav txiav txim siab tsis ncaj qha cov paib - hypertrophy ntawm lub tuam tsev, kev cuam tshuam kev sib dhos;
- MRI yuav muab cov duab peb sab ntawm lub plawv thiab txiav txim siab qib ntawm cov tuab ntawm myocardium;
- ventriculography txiav txim siab ua haujlwm ua haujlwm.
Kev kho mob myocardial hypertrophy
Lub hom phiaj tseem ceeb ntawm kev kho mob yog los kho qhov loj ntawm myocardium yav dhau los. Cov txheej txheem uas yog tsom rau qhov no yog ua nyob rau hauv ib tug complex. Muaj feem yuav kho tau hypertrophy yog tias tau kuaj pom ntxov. Ib feem tseem ceeb ntawm kev kho mob myocardial yog txoj kev ua neej. Nov yog cov cai ua rawskws kho mob:
- tsum tsum smoking;
- khoom noj;
- txo qhov hnyav;
- txwv ntsev kom tsawg;
- tshem tawm tshuaj;
- txiav cawv.
Kev kho mob ntawm sab laug ventricular myocardial hypertrophy nrog tshuaj suav nrog kev noj tshuaj uas:
- kho lub plawv tsis sib xws (antiarrhythmics);
- txo cov ntshav siab - angiotensin receptor antagonists, ACE inhibitors;
- tshuaj nrog qhov tsis zoo ionotropic los so lub plawv - calcium antagonists los ntawm pawg verapamil, beta-blockers;
- nce nqaij muaj zog - ionotropics;
- tshem tawm kua - diuretics;
- nrog kev hem thawj ntawm kab mob endocarditis - tshuaj tua kab mob prophylaxis.
Nws yog qhov yuav tsum tau ua rau tus kws kho mob tuaj koom xaiv tshuaj. Kev noj tshuaj rau tus kheej tsis tuaj yeem lees txais thiab ua rau muaj qhov tshwm sim loj.
Yuav ua li cas yog tias muaj tus kab mob no? Ib txoj hauv kev zoo ntawm kev kho mob uas yuav tso cai rau koj los hloov cov contractions ntawm lub ventricles thiab chav kawm ntawm excitation yog dual-chamber pacing. Hauv cov xwm txheej nyuaj, nrog asymmetric IVS hypertrophy, latent obstruction, tsis muaj kev cuam tshuam ntawm cov tshuaj, cov hauv qab no yuav pab cawm tus neeg mob txoj sia:
- pacemaker implantation;
- excision ntawm lub lobe ntawm lub interventricular septum;
- txhim kho lub defibrillator;
- transortal septal myectomy;
- transcatheter septal cawv ablation.
Ntawm no txhua yam yuav nyob ntawm qhov kev loj hlob ntawm pathology thiab mobtus neeg mob nws tus kheej. Peb tshuaj xyuas cov tsos mob thiab kev kho mob ntawm sab laug ventricular hypertrophy ntawm lub plawv.
